Individual
DR. JACOB STEPHEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
1850 GATEWAY DR, SYCAMORE, IL 60178-3192
(630) 232-0280
(630) 232-3895
Mailing address
5 KISH HOSPITAL DR STE 103, DEKALB, IL 60115-9602
(630) 232-0280
(630) 232-3895
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
35.083380
OH
207RI0011X
Interventional Cardiology Physician
Primary
036133593
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
206147
MEDICARE GROUP PTAN
IL
01
—
F40332641
MEDICARE INDIVID PTAN
IL
Enumeration date
09/26/2006
Last updated
08/15/2024
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